Alcohol Use and Psychiatric Comorbidity: A Phenotypic perspective

1. Alcohol Use and Psychiatric Comorbidity: A Phenotypic perspective K. Thennarasu, Kathleen K Bucholz and Rosalind J Neuman Department of Psychiatry, Washington University School of Medicine, St. Louis, MO

2. Objectives • To establish homogeneous alcohol user classes based on comorbidities using latent class analysis. • To validate latent phenotypic classes using external covariates. • To find similarity between latent phenotypic classes using multi dimensional scaling.

3. Data Source • National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), 2000-2001. • 43,093 non-institutionalized household residents • aged >=18 years • NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV)

4. Methods* I • NESARC data were divided in to five discrete groups • Abstainers • No alcohol diagnosis • Abuse only • Dependence only • Abuse and dependence only • Used the following 9 comorbid diagnosis to determine latent structure of each of the above groups • Major Depressive Disorder • Panic Disorder and Agoraphobia • Social Phobia • Specific Phobia • Generalized Anxiety Disorder • Obsessive Compulsive Disorder • Antisocial Personality Disorder • Nicotine dependence • Other drug dependence * All diagnosis are based on DSM IV

5. Methods II • External validators • Gender • Age • Education • Ethnicity • Mental health scale • Physical function scale* • Family history of alcohol problem • Age at onset of alcohol use* • Age at onset of everyday smoking * Results not shown in this display

6. Prevalence of co-morbiditiesin each group

7. Model selection: BIC comparison Number of Latent classes

8. Abstainers 4 latent classes Group baseline prevalence

9. No alcohol Dx group5 latent classes Group baseline prevalence

10. Abuse only group4 latent classes Group baseline prevalence

11. Dependence only group3 latent classes Group baseline prevalence

12. Abuse & Dependence group 5 latent classes Group baseline prevalence

13. Validator: Sex % of Males Distribution by latent class ██ Abstainers,██No alcohol Dx,██Abuse only, ██Dependence only,██Abuse & dependence

14. Validator: Age Age (years) Distribution by latent class ██ Abstainers,██No alcohol Dx,██Abuse only, ██Dependence only,██Abuse & dependence

15. Validator: Education Education (Years) Distribution by latent class ██ Abstainers,██No alcohol Dx,██Abuse only, ██Dependence only,██Abuse & dependence

16. Validator: Ethnicity % Whites Distribution by latent class ██ Abstainers,██No alcohol Dx,██Abuse only, ██Dependence only,██Abuse & dependence

17. Validator: Family History Family History % Distribution by latent class ██ Abstainers,██No alcohol Dx,██Abuse only, ██Dependence only,██Abuse & dependence

18. Validator: Mental Health Scale Norm based Mental Health Scale Distribution by latent class ██ Abstainers,██No alcohol Dx,██Abuse only, ██Dependence only,██Abuse & dependence

19. Biplot using Multi Dimensional Scalingbased on principal normalization Dimension 2 29.4% Dimension 1 54.9% Total Variance Accounted: 84.3%

20. Summary • Need to include comorbidities when defining alcohol phenotypes • Phenotypic characteristics of some latent classes are unique • Biplot results shows existence of similar latent classes across groups • Latent class phenotypes will reduce heterogeneity